Clinical, functional and radiological outcomes of proximal femoral nail (PFN) with proximal femoral nail antirotation Asia (PFNA2) in the treatment of intertrochanteric and peritrochanteric femur fracture

Abstract

Background: The incidence of unstable intertrochanteric fractures is increasing due to increased life span. These fractures require stable fixation and early mobilisation to reduce the morbidity and mortality. Extramedullary implants are biomechanically inferior in these cases. The Proximal Femoral Nail (PFN) and Proximal Femoral Nail Antirotation Asia (PFNA2) is an intra-medullary nail system designed for such fractures in the Asian population. Materials and methods: 61 patients with unstable intertrochanteric fractures who presented to us between 1st May 2019 to 20th February 2020 were treated with PFN & PFNA-II. The clinical, functional & radiological outcomes of these patients were assessed. Out of 61 patients, 11 patients were not included in the study; 5 patients didn’t gave consent for the inclusion in the study and remaining 6 patients were lost to follow up. Results: Mean operative time for PFN was 56 minutes & for PFNA2 was 45 minutes. The mean amount of blood loss for PFN is 102 ml & for PFNA2 is 90 ml. Mean radiological union time was 14.05 weeks for PFN & 12.23 weeks for PFNA2. The functional status according to Harris hip score was excellent in 8, good in 9, fair in 7 cases and poor in 1 case in PFN & excellent in 10, good in 12, fair in 3 cases and poor in 0 case in PFN. Mean Harris hip score is 84 in PFN & 88 in PFNA2. Conclusion: PFNA2 is an optimum implant for the internal fixation of intertrochanteric & peritrochanteric femur fractures in elderly patients with advantages of a simple operation, very few complications, and good clinical efficacy, less surgical operative time, stable fixation, early load sharing fixation, early weight bearing and ambulation, shortened hospital stay and improved rate of union with early resumption of independent life style, excellent functional outcome, less soft tissue dissection and less blood loss, less time interval between Injury and Surgery, less fluoroscopy images, less length of surgical incision & Improved Harris hip score.